Do Web-Based Interventions Improve Well-Being in Type 2 Diabetes? A Systematic Review and Meta-Analysis

BACKGROUND: Poor diabetes self-care can have a negative impact on psychological well-being and quality of life. Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs, Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions. However, there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes. OBJECTIVE: This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes. METHODS: Searches were carried out in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library. Reference lists were hand-searched. A meta-analysis was conducted for depression and distress outcomes. RESULTS: A total of 16 randomized controlled studies met the inclusion criteria for the systematic review and 9 were included in the meta-analyses. Theories were applied to the majority of the interventions. The most common behavior change techniques were "General information" and "Tracking/monitoring." Interventions with a duration of 2-6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes. The pooled mean (95% confidence interval) difference between the intervention and control arms at follow-up on depression score was -0.31 (-0.73 to 0.11). The pooled mean difference on distress scores at follow-up was -0.11 (-0.38 to 0.16). No significant improvements in depression (P=.15) or distress (P=.43) were found following meta-analyses. CONCLUSIONS: While the meta-analyses demonstrated nonsignificant results for depression and distress scores, this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes. Further research is required to confirm the findings of this review

Simultaneous siRNA Targeting of Src and Downstream Signaling Molecules Inhibit Tumor Formation and Metastasis of a Human Model Breast Cancer Cell Line

Src and signaling molecules downstream of Src, including signal transducer and activator of transcription 3 (Stat3) and cMyc, have been implicated in the development, maintenance and/or progression of several types of human cancers, including breast cancer. Here we report the ability of siRNA-mediated Src knock-down alone, and simultaneous knock-down of Src and Stat3 and/or cMyc to inhibit the neoplastic phenotype of a highly metastatic human model breast cancer cell line, MDA-MB-435S, a widely used model for breast cancer research.Src and its downstream signaling partners were specifically targeted and knocked-down using siRNA. Changes in the growth properties of the cultured cancer cells/tumors were documented using assays that included anchorage-dependent and -independent (in soft agar) cell growth, apoptosis, and both primary and metastatic tumor growth in the mouse tumor model. siRNA-mediated Src knock-down alone, and simultaneous knock-down of Src and Stat3 and/or cMyc inhibited the neoplastic phenotype of a highly metastatic human model breast cancer cell line, MDA-MB-435S. This knock-down resulted in reduced growth in monolayer and soft agar cultures, and a reduced ability to form primary tumors in NOD/SCID mice. In addition, direct intra-tumoral injection of siRNAs targeting these signaling molecules resulted in a substantial inhibition of tumor metastases as well as of primary tumor growth. Simultaneous knock-down of Src and Stat3, and/or Myc exhibited the greatest effects resulting in substantial inhibition of primary tumor growth and metastasis.These findings demonstrate the effectiveness of simultaneous targeting of Src and the downstream signaling partners Stat3 and/or cMyc to inhibit the growth and oncogenic properties of a human cancer cell line. This knowledge may be very useful in the development of future therapeutic approaches involving targeting of specific genes products involved in tumor growth and metastasis

Emerging themes in dietetic competency [Conference Abstract]

Determining entry level competency of new graduates, as they transition from university to practice is not always black and white. Holistic competency emerges as acculturation and experience develops in the workplace. This project, funded by the Dietitians Association Australia (DAA), aimed to develop tools to guide the assessment process. Range variable statements and evidence guides were developed to inform the assessment of DAA Entry Level Competency Standards (ELCS) at university and to define the core fields of study required in Australian university curricula for university accreditation and international benchmarking purposes. Range variables contextualise competency by defining the boundaries for competency and the associated performance criteria. Evidence guides provide the range of contexts and critical aspects of competency which would usually be assessed together. Core fields of study defi ne the underpinning knowledge and skills required in the curriculum to achieve competency. Draft range variable statements and evidence guides were developed against each of the units and elements of the ELCS. Two rounds of consultation occurred with the fourteen Australian universities undertaking dietetic education and the project management committee, via teleconference and email. Core fi elds of study were informed by these consultations, as well as interviews of new graduates about core activities undertaken in their workplace. The final versions of these documents were presented to the project management committee, the Australian Dietetic Council and the DAA Board to be integrated into the DAA Accreditation Manual and website information

A leap into foodservice satisfaction in the private acute care setting [Conference Abstract]

Monitoring foodservice satisfaction is a risk management strategy for malnutrition in the acute care sector, as low satisfaction may be associated with poor intake. This study aimed to investigate the relationship between age and foodservice satisfaction in the private acute care setting. Patient satisfaction was assessed using a validated tool, the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire for data collected 2008–2010 (n = 779) at a private hospital, Brisbane. Age was grouped into three categories; 70 years. Fisher’s exact test assessed independence of categorical responses and age group; ANOVA or Kruskal–Wallis test was used for continuous variables. Dichotomised responses were analysed using logistic regression and odds ratios (95% confidence interval, p 70 years vs 40.6% ≤50 years; p 70 years vs 35.9% ≤50 years; p 70 years (OR = 5.0, 95% CI: 1.8–13.8; <50 years referent). These results suggest that dimensions of foodservice satisfaction are associated with age and can assist foodservices to meet varying generational expectations of clients

Src siRNA causes apoptosis of MDA-MB-435S cells.

<p>MDA-MB-435S cells were transfected with siRNA or treated with 1 uM staurosporine. 48 hours post-treatment, the cells were collected and assayed for apoptosis using the TUNEL assay. Results are expressed with log(fluorescence) on the horizontal axis and cell counts on the vertical axis and is representative of triplicate experiments.</p

Injection of siRNA/oligofectamine complexes into mouse tumors inhibits tumor growth.

<p>MDA-MB-435S cells were implanted in the mammary fat pad of SCID/NOD mice. Two days post-implantation, the mice were divided into 3 groups (one group of 10 control siRNA-injected mice and two groups of 5 targeted siRNA mice) and the groups received twice weekly injections of either control, Src+STAT3, or Src+STAT3+Myc siRNA into the site of the cell implantation/tumor. 47 days post-implantation, 5 mice in the control group were switched to Src+STAT3 siRNA injections for the remainder of the experiment (Control, then Src+STAT3 group). Tumor growth was monitored and the results are shown (<b>A</b>), with each treatment group shown in a single panel, and individual mouse tumors represented by connected data points. 126 days post-implantation, the primary tumor(s) were excised (<b>B</b>) and weighed. The tumor weights for each mouse (data points) and the average tumor weight for each group (horizontal bar) is shown (<b>C</b>). Tumor weight data was analyzed by Analysis of Variance and Tukey's pairwise comparison, with significant differences between the control group and two of the treatment groups noted ( *p<0.05).</p

Src and some of the signaling pathways downstream of Src.

<p>Src regulates several downstream signaling pathways including the STAT3 pathway, the PI3K pathway, and the MAPK pathway.</p

Src+STAT3 siRNA reduces tumor formation in NOD/SCID mice.

<p>1×10⁶ cells transfected with control (mice 1–4) or Src+STAT3 siRNAs (mice 5–8) were implanted into the mammary fat pad of mice. After 66 days, the tumors were excised and weighed (significant differences are indicated (*; p<0.05)(<b>A</b>). Sections of the tumor were stained (<b>B</b>) or subjected to immunostaining with anti-GFP antibody (<b>C</b>). Malignant cells are indicated by an arrow. A portion of each tumor was homogenized with RIPA buffer and immunoblotted with anti-GFP antibodies (<b>D</b>).</p

Src siRNA causes reductions in Src protein and activity and inhibits cell growth.

<p>MDA-MB-435S cells were left untreated or transfected with control or Src siRNA. 24 hours later, some cells were plated into soft agar or tissue culture dishes. After 48 hours, the remainder of the cells were processed for Src immunoblots or Src kinase activity. The results from the immunoblot and kinase assay were quantitated, the results are shown, and significant differences are indicated (* and **; p<0.05) (<b>A</b>). The cells in soft agar were grown for 14 days and colonies were quantitated (<b>B</b>) with significant differences indicated (*; p<0.05). The cells in monolayers were quantitated 5 days after plating and the significant differences indicated (*; p<0.01) (<b>C</b>). Each data point is the mean of duplicate (western and kinase) or triplicate (soft agar and monolayer) samples +/−1 S.D. and is representative of at least 3 independent experiments.</p